Module 31-Orthopaedic Injuries

Which of the following are goals of in-line traction?

*Stabilize the fragments to prevent movement *Align the limb for splinting *Avoid neurovascular compromise

In which situations should you splint the limb in the position of deformity?

*When you encounter resistance or extreme pain when applying traction *When the deformity is the result of a dislocation and is severe.

Epiphyseal fracture

A fracture that occurs in a growth section of a child's bone and may lead to growth abnormalities

crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

locked joint

A joint that is locked into position and painful to move.

articular cartilage

A pearly white layer of specialized cartilage covering the articular surfaces (contact surfaces on the ends) of bones in synovial joints.

pectoral girdle

AKA shoulder girdle; consists of two scapulae (should blades) and two clavicles (collarbones)

sling

Any bandage or material that helps support the weight of an injured upper extremity

What is the primary goal of in-line traction?

Avoid further neurovascular compromise

Types of fractures

Comminuted Epiphyseal Greenstick Incomplete Oblique Pathologic Spiral Transverse

Which of the following statements regarding compartment syndrome is correct?

Compartment syndrome typically develops within 6 to 12 hours after an injury.

Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome?

Disproportionate pain

T or F? Fractures of the proximal femur usually involve the hip joint.

False. Fractures of the proximal femur are usually called hip fractures, but they rarely involve the hip joint.

T or F? If you are unable to restore the distal pulse on scene, you should splint the limb in a straight position and provide prompt transport to the hospital.

False. If you are unable to restore distal pulse, splint the limb in the position that is comfortable for the patient and provide prompt transport to the hospital.

In which of the following situations should the EMT splint an injured limb in the position of deformity?

If resistance is encountered or the patient experiences severe pain

false motion

Movement that occurs in a bone at a point where there is no joint, indicating a fracture; also called free movement.

point tenderness

Pain produced when an injury site is palpated

displaced fracture

Produces actual deformity or distortion of the limb by shortening rotating or angulating it

thoracic cage

Protects the heart, lungs, and great vessels; the lower ribs protect the liver and spleen

Three types of muscles in the muscular system:

Skeletal Smooth Cardiac

When in doubt, ____________.

Splint

You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury?

Splint from the shoulder joint to the wrist joint to stabilize the entire arm.

compartment syndrome

Swelling within a confined anatomic compartment that produces dangerous pressure, characterized by extreme pain, decreased pain sensation, pain on stretching of affected muscles, and decreased power.

Which of the following is a drawback of an air splint?

Temperature changes affect air pressure in the splint

tourniquet

The bleeding control method used when a wound continues to bleed despite the use of direct pressure and elevation; useful if a patient is bleeding severely from a partial or complete amputation.

The musculoskeletal system refers to the:

The bones and voluntary muscles of the body.

glenoid fossa

The part of the scapula that joins with the humeral head to form the glenohumeral joint.

T or F? A fracture of the femoral shaft is best stabilized with a traction splint, such as a Sager splint.

True.

T or F? Lateral and medial dislocations to the knee are less common than posterior dislocations and are less likely to injure the popliteal artery.

True.

fascia

a band or sheet of fibrous connective tissue that covers, supports, and separates muscle

swathe

a bandage that passes completely around the chest, must be used to bind the arm to the chest wall

fracture

a break in the continuity of a bone

dislocation

a disruption of a joint in which the bone ends are no longer in contact

splint

a flexible or rigid device that is used to protect and maintain the position of an injured extremity

spiral fracture

a fracture caused by a twisting or spinning force, causing a long, spiral-shaped break in the bone. This is sometimes the result of abuse in young children

oblique fracture

a fracture in which the bone is broken at an angle across the bone; This is usually the result of a sharp, angled blow to the bone

comminuted fracture

a fracture in which the bone is broken into more than two fragments

pathologic fracture

a fracture of weakened or diseased bone, seen in patients with osteoporosis, infection, or cancer; often produced by minimal force

incomplete fracture

a fracture that does not run completely through the bone; a nondisplaced partial crack

transverse fracture

a fracture that occurs straight across the bone; this is usually the result of a direct-blow injury

acromioclavicular (AC) joint

a simple joint where the bony projections of the scapula and the clavicle meet at the top of the shoulder

greenstick fracture

an incomplete fracture that passes partway through the shaft of the bone but may still cause substantial angulation; occurs in children

amputation

an injury in which an extremity is severed completely from the body

three classes of foot bones

ankle bones (tarsals) foot bones (metatarsals) toe bones (phalanges)

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should:

apply gentle manual traction in line with the limb and reassess for a pulse.

With regard to musculoskeletal injuries, the zone of injury is defined as the:

area of soft-tissue damage surrounding the injury

ligaments

band of fibrous connective tissue that connects bone to bone

A fracture is MOST accurately defined as a(n):

break in the continuity of the bone.

closed fracture

broken bone with no open wound

Joints are held together in a tough, fibrous structure known as a _____.

capsule

When caring for a patient with a possible fracture of the scapula, the EMT should:

carefully assess the patient for breathing problems

lower extremity

consists of bones of the thigh, leg and foot

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should

control the bleeding and cover the wound with a sterile dressing

signs of fracture include:

deformity tenderness guarding swelling bruising crepitus false motion exposed fragments pain locked joint

The MOST significant hazard associated with splinting is:

delaying transport of a critically injured patient

ecchymosis

discoloration; bruise

A disruption of a joint in which the bone ends are no longer in contact is known as what?

dislocation

Which of the following musculoskeletal injuries would MOST likely result in deformity?

displaced fracture

A supracondylar or intercondylar fracture is also known as a fracture of the:

distal humerus

upper extremity

extends from the shoulder to the fingertips

nondisplaced fracture

hairline fracture; a simple crack of the bone that may be difficult to distinguish from a sprain or simple contusion

calcaneus

heel bone, largest of the tarsal bones

Which MOI causes a fracture or dislocation at a distant point?

indirect force

zone of injury

injury to the soft tissues surrounding the bones and joints, especially to the adjacent nerves and blood vessels

A 17-year-old female dislocated her patella while playing soccer. Her knee is flexed and she complains of severe pain. You should

keep her knee flexed and secure it with padded board splints

Joint capsules are supported and strengthened in certain key areas by ______________.

ligaments

pelvic binder

meant to provide temporary stabilization until definitive immobilization can be acheived

sprain

occurs when a joint is twisted or stretched beyond its normal range of motion

open fracture

one in which the bone is broken and there is an open wound in the skin

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life?

pelvic fracture with hypotension

Joints

places where two bones come into contact

What is the most reliable indicator of an underlying fracture?

point tenderness

When assessing distal circulation in a patient's lower extremities, which pulse should you palpate?

popliteal pulse

Crepitus and false motion are:

positive indicators of a fracture.

The primary purpose for splinting a musculoskeletal injury is to:

prevent further injury

A "hip" fracture is actually a fracture of the:

proximal femur

strain

pulled muscle; a stretching or tearing of the muscle and/or tendon, causing pain, swelling, and bruising of the soft tissues in the area

A patient with a ___________ limb must be given a higher priority.

pulseless

Musculoskeletal

refers to the bones and voluntary muscles of the body

three basic types of splints are:

rigid formable traction

In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel?

serious

If a patient has two or more injured extremities, treat the patient as a __________ ___________ patient and provide rapid transport to the hospital.

significant trauma

Which of the following would you use to stabilize an AC separation?

sling and swathe

The bony ____________ ____________ encases and protects the __________ __________.

spinal canal spinal cord

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:

stabilize her head and perform a primary assessment

During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should:

stabilize the pelvis with a pelvic binder and protect the spine

pelvis

supports the body weight and protects structures within the pelvis (bladder, rectum, female reproductive organs) ischium, ilium and pubis

Skeletal muscle is attached to the bone by tough, ropelike, fibrous structures called:

tendons

sciatic nerve

the largest nerve in the lower extremity; controls the activity of muscles in the posterior thigh and below the knee and the sensation in most of the leg and foot

traction

the most effective way to realign a fracture of the shaft of a long bone so that the limb can be splinted more effectively

An open fracture is MOST accurately defined as a fracture in which:

the overlying skin is no longer intact.

In general, musculoskeletal injuries should be splinted before moving the patient unless:

the patient is clincally unstable.

compartment syndrome most commonly occurs with a fractured __________ in adults or ___________ forearm in children and can be overlooked, especially in patients with an altered LOC.

tibia forearm

lower leg bones

tibia--aka shinbone, larger of two leg bones, supports major weight bearing surface of knee and ankle fibula--runs behind and beside tibia, serves as anchor for ligaments surrounding the knee joint and forms lateral side of ankle joint

reduce

to return a dislocated joint or fractured bone to its normal position; to set

skull

vaultlike structure that surrounds and protects the brain

When not to splint:

when the deformity is severe when you encounter resistance or extreme pain when applying gentle traction to the fracture of a shaft of a long bone